Effect of neuromuscular electrical stimulation on the recovery of people with COVID-19 admitted to the intensive care unit: A narrative review

Louise C Burgess, Lalitha Venugopalan, James Badger, Tamsyn Street, Gad Alon, Jonathan C Jarvis, Thomas W Wainwright, Tamara Everington, Paul Taylor, Ian D Swain, Louise C Burgess, Lalitha Venugopalan, James Badger, Tamsyn Street, Gad Alon, Jonathan C Jarvis, Thomas W Wainwright, Tamara Everington, Paul Taylor, Ian D Swain

Abstract

The rehabilitation of patients with COVID-19 after prolonged treatment in the intensive care unit is often complex and challenging. Patients may develop a myriad of long-term multiorgan impairments, affecting the respiratory, cardiac, neurological, digestive and musculoskeletal systems. Skeletal muscle dysfunction of respiratory and limb muscles, commonly referred to as intensive care unit acquired weakness, occurs in approximately 40% of all patients admitted to intensive care. The impact on mobility and return to activities of daily living is severe. Furthermore, many patients experience ongoing symptoms of fatigue, weakness and shortness of breath, in what is being described as "long COVID". Neuromuscular electrical stimulation is a technique in which small electrical impulses are applied to skeletal muscle to cause contractions when voluntary muscle contraction is difficult or impossible. Neuromuscular electrical stimulation can prevent muscle atrophy, improve muscle strength and function, maintain blood flow and reduce oedema. This review examines the evidence, current guidelines, and proposed benefits of using neuromuscular electrical stimulation with patients admitted to the intensive care unit. Practical recommendations for using electrical muscle stimulation in patients with COVID-19 are provided, and suggestions for further research are proposed. Evidence suggests NMES may play a role in the weaning of patients from ventilators and can be continued in the post-acute and longer-term phases of recovery. As such, NMES may be a suitable treatment modality to implement within rehabilitation pathways for COVID-19, with consideration of the practical and safety issues highlighted within this review.

Keywords: COVID-19; coronavirus infection; critical care; muscular atrophy; neuromuscular electrical stimulation; rehabilitation.

Conflict of interest statement

The authors have no conflicts on interest to declare.

Figures

Fig. 1
Fig. 1
Electrode positioning for electrical stimulation of the quadriceps (posed with a mannequin).
Fig. 2
Fig. 2
Electrode position for electrical stimulation of the peroneal nerve for increased blood flow to the lower limb (posed with a mannequin).
Fig. 3
Fig. 3
Characteristics of a patient admitted to the intensive care unit (ICU) with COVID-19. ICUAW: intensive care unit acquired weakness; DVT: deep vein thrombosis.
Fig. 4
Fig. 4
Examples of neuromuscular electrical stimulation (NMES) application for patients admitted to the intensive care unit (ICU) with COVID-19, by indication. ICUAW: intensive care unit acquired weakness; DVT: deep vein thrombosis; FES: functional electrical stimulation; VTE: Venous thromboembolism.

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